Provider Demographics
NPI:1518924653
Name:WILDER, THOMAS WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:WILDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8919 PARALLEL PKWY STE 270
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1655
Mailing Address - Country:US
Mailing Address - Phone:913-334-6800
Mailing Address - Fax:913-334-0875
Practice Address - Street 1:8919 PARALLEL PKWY STE 270
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1655
Practice Address - Country:US
Practice Address - Phone:913-334-6800
Practice Address - Fax:913-334-0875
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28646208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100370340BMedicaid
KS100370340BMedicaid
KSKA13714002Medicare PIN
H20108Medicare UPIN